IMPACT OF COVID ON PERSON AND FAMILY ENGAGEMENT IN ASSISTED LIVING

Abstract Advancing person-centered care in assisted living (AL), while minimizing safety risks (e.g., injury, elopement, or medication errors), requires effective partnerships among residents, family members, and staff. The COVID-19 pandemic adversely affected capacity across and within AL settings to establish and nurture these relationships, ultimately affecting and changing person and family engagement in care. Using data from qualitative interviews, we will report findings about person and family engagement in the safety of AL from the perspectives of 104 residents, families, and staff. Particular attention will be given to examining the effect of COVID-19 on person and family engagement for residents at increased risk for disparities in assisted living, including residents who are living with mild cognitive impairment or dementia. The presentation highlights both challenges and promising practices that emerged from the COVID-19 pandemic. Implications for AL are presented to support the transition from pandemic to endemic.

United States,5. Accenture,Charlotte,North Carolina,United States The Older Americans Act Nutrition Services Program's congregate meals support food security and nutrition, promote socialization, and improve quality of life. Understanding what drives people to first attend a congregate meal program may support efforts to increase involvement. This study used the 2019 National Survey of Older Americans Act Participants to analyze the openended survey responses of congregate meal participants (N=1,072) on why they started attending the program. The top three reasons were that they sought socialization (36.3%), had a medical or age-related need (18.7%), or accompanied or were referred by a friend or relative (12.3%). We conducted descriptive analyses on differences in the demographic, socioeconomic, and health characteristics of those attending for socialization compared to others. Results indicated a relationship between attending congregate meals for socialization and several characteristics: these individuals are more often non-Hispanic white (p< 0.05), widowed (p< 0.05), aged 75 to 84 (p< 0.05), and have at least a high school education (p< 0.01). People who attend for socialization are also less likely to be lower income (p< 0.01), living in cities (p< 0.001), have food insecurity (p< 0.01), and living with three or more ADLs (p< 0.01). Findings suggest two subpopulations of congregate meal attendees: those who have the choice to attend and do so for socialization, and those who attend because of unmet needs (e.g., food insecurity or disability). Identification of different categories of participants and what drives them to attend congregate meal sites has implications for improvements to advertising congregate meal services, targeting of certain populations, and ultimately to increasing participation.

SIMULATING WELL-BEING AND LITERACY INTERVENTIONS TO REDUCE ELDER SCAM SUSCEPTIBILITY
Marguerite DeLiema 1 , and Aparajita Sur 2 , 1. University of Minnesota,Twin Cities,Minneapolis,Minnesota,United States,2. University of Minnesota,Minneapolis,Minnesota,United States Finanical fraud targeting older adults is on the rise, with annual losses in the billions of dollars. There is little longitudinal research on the causal relationships between known risk factors and scam susceptibility, including poor psychological well-being and poor health and financial literacy. Interventions designed to enhance well-being and/or literacy may reduce scam susceptibly among older adults. In this study, we use repeated measures from the Rush Memory and Aging Project to simulate how different trajectories in well-being and literacy might impact scam susceptibility among older adults alive over a seven year period. We simulated the effects of interventions of varying degrees --10%, 50%, and 100% increase in well-being/literacy from baseline scores. Simulations were performed for all participants as well as by education and income subgroups. Simulation models show that intervening on well-being causes a greater reduction in average scam susceptibility over time compared to intervening on total literacy. Even a 10% increase in baseline well-being significantly reduces scam susceptibility over time, regardless of participants' baseline income or educational attainment. Both interventions caused slightly greater reductions in susceptibility for those who are not college educated and those with an annual household income of less than $30,000. This study suggests that interventions that target self-efficacy and sense of purpose may help reduce older adults' scam susceptibility even more than interventions that improve health and financial literacy, but that both are promising targets for intervention.

PRESIDENTIAL SYMPOSIUM: REIMAGINING AGING AND LONG-TERM CARE FOR HEALTH EQUITY DURING AND POST-COVID-19: A HEALTH SCIENCES FOCUS Chair: Kirsten Corazzini Discussant: Deb Bakerjian
In line with the theme of the conference, this symposium highlights exemplars of health sciences scholars who are identifying key issues and opportunities to re-imagine aging and long-term care, through a health equity lens, as highlighted by COVID-19. This lens is inclusive of the wide range of long-term care stakeholders whose well-being and health outcomes have been affected throughout the COVID-19 pandemic, including older adults, family caregivers, and the healthcare workforce. We focus in particular on vulnerable aging populations, such as older adults who are living with neurocognitive disorders, racial/ethnic minority older adults, and older adults receiving palliative care. Finally, we consider these issues at both individual and systems-levels. Our first presenter examines person and family engagement in assisted living for older adults living with ADRD and the impact of COVID-19. The second presenter provides insights into palliative care needs in nursing homes, and the implications for transition to an endemic. The third presenter examines long-term care needs in the community, with a focus on the consequences of unmet needs for racial/ethnic minority older adults. The fourth presenter highlights the role and capacity of the nurse practitioner in nursing homes during COVID. Our final presenters provide a systems-level look at the COVID-19 response, focusing on self-organizing community coalitions to support nursing homes. Presentations reveal how re-imagining aging and long-term care in health sciences, requires consideration of health inequities experienced throughout COVID-19, whether newly emerging inequities, or long-standing challenges and inequities that have been exacerbated by COVID-19.

IMPACT OF COVID ON PERSON AND FAMILY ENGAGEMENT IN ASSISTED LIVING Anna Beeber, Johns Hopkins University, Baltimore, Maryland, United States
Advancing person-centered care in assisted living (AL), while minimizing safety risks (e.g., injury, elopement, or medication errors), requires effective partnerships among residents, family members, and staff. The COVID-19 pandemic adversely affected capacity across and within AL settings to establish and nurture these relationships, ultimately affecting and changing person and family engagement in care. Using data from qualitative interviews, we will report findings about person and family engagement in the safety of AL from the perspectives of 104 residents, families, and staff. Particular attention will be given to examining the effect of COVID-19 on person and family engagement for residents at increased risk for disparities in assisted living, including residents who are living with mild cognitive impairment or dementia. The presentation highlights both challenges and promising practices that emerged from the COVID-19 pandemic. Implications for AL are presented to support the transition from pandemic to endemic.

PALLIATIVE CARE FOR NURSING HOME RESIDENTS: APPLYING LESSONS LEARNED FROM COVID-19
Kathleen Unroe, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, United States Many people receive care near or at the end of life in nursing homes, including 70% of people with Alzheimer's Disease and Related Dementias (ADRD). Studies have documented unmet needs for symptom management and frequent transitions of care for nursing home residents. Despite this, access to palliative care for nursing home residents is inconsistent. The COVID-19 pandemic both highlighted and exacerbated inequities in access to care, including in US-based nursing homes, as well as globally. COVID-19 specific guidance for nursing homes at state and federal levels, while designed to protect residents, contributed to increased social isolation and functional decline. Drawing upon data from an ongoing study to advance palliative care for residents living with ADRD, this presentation will highlight promising practices and opportunities to deliver palliative care in this setting.

ADDRESSING UNMET LONG-TERM SERVICES AND SUPPORTS NEEDS FOR RACIAL/ETHNIC MINORITY OLDER ADULTS Jasmine Travers, NYU, New York City, New York, United States
The COVID-19 pandemic magnified several long-standing problems with the delivery of long-term services and supports, including access to care in the community setting. A disproportionate rise in nursing home use among Black and Latino older adults reflects the inadequacy of existing programs and policies to support aging in place for these most at-risk populations. Enabling aging in the community and preventing avoidable nursing home placements is widely considered a priority by federal, state, and local entities along with families and older adults. Yet, it is unclear what is needed to support Black and Latino older adults to remain in the community. In this presentation, Dr. Travers will discuss unmet long-term services and supports needs among the Black and Latino population, issues particularly faced by these populations during COVID-19, and opportunities to move forward as we transition to an 'endemic' COVID-19 landscape.

THE LONG-TERM CARE STAFFING CRISIS AND COVID-19: ROLE OF THE NURSE PRACTITIONER Katherine McGilton, KITE Research Institute: Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada
The residential long-term care sector has historically suffered from seemingly intractable staffing challenges in terms of ensuring adequate clinical expertise and a supportive work environment to address the complex health care needs of residents. Considerable evidence has demonstrated the devastating effect of COVID-19 on this fragile residential long-term care staffing structure, resulting in adverse outcomes among staff and residents alike, with the potential for permanent devastation without directed intervention. Drawing upon data from an Ontario-based study of nurse practitioner deployment during COVID-19, this talk will share an emergent approach to re-shaping expertise and capacity in Ontario, Canada through embedding nurse practitioners in residential long-term care homes. Results of this work helped to inform health policy action in the province to scale-up the use of nurse practitioners in long-term care homes, in order to enhance staff expertise and tackle the significant inequities of access to care among nursing home residents.

A LOOK INSIDE THE MISSOURI NURSING HOME COVID-19 EXPERIENCE Amy Vogelsmeier, and Lori Popejoy, University of Missouri, Columbia, Missouri, United States
The COVID-19 pandemic exposed the vulnerabilities of US nursing homes to manage widespread viral outbreaks including an ill prepared/under-resourced workforce, a physical environment not conducive to infection prevention or management, and isolation from community emergency response planning. In this session, we will share real-life, real-time experiences of diverse Missouri nursing homes as they responded to the COVID-19 pandemic. We will also report on emerging data about the impact of nursing homes' pandemic response on resident outcomes. Strategies such as community-based efforts to respond to resource scarcity, and creative workforce solutions to address staffing needs, will be shared. Critical next steps should focus on the implementation of community coalitions to create sustainable healthcare partnerships at the local and state level and enhanced workforce solutions that include registered nurses and advanced practice registered nurses working within nursing homes to guide clinical care and infection prevention and management strategies.

READY, FIRE, AIM: DOES INTEGRATING ACUTE AND LONG-TERM SERVICES WORK?
Chair: Robert Applebaum Discussant: Richard Browdie Due to the increasing costs of Medicaid and Medicare and concerns about how these two programs fail to work together to deliver quality care, there has been a growing enthusiasm for integrated care programs. The Financial Alignment Initiatives (FAI), implemented by the Centers for Medicare and Medicaid Services (CMS) in 2011 and tested